Post-Traumatic Stress Disorder (PTSD) and Crisis Management Part 2 In this presentation we will: Define the principles of effective intervention Describe.

Post-Traumatic Stress Disorder (PTSD) and Crisis Management

Part 2

In this presentation we will:

• Define the principles of effective intervention

• Describe stages of crisis reaction & interventions at each stage

• Explain the debriefing model and issues surrounding its use

Guiding Principles of Intervention

Proximity-- Intervene close or in the setting where crisis occurred to facilitate reintegration

Commitment-- Be active, involved, directive, available. Give information, set limits, give support, dispel myths, discourage denial, avoid projection.

Concurrence-- Link survivor to social supports to share response burden, establish caring relationships, build skills, give feedback, and enhance use of community.

Expectancy-- Emphasize the positive, develop hope for constructive outcome, develop access to personal resources, make best of bad situation, can become more resilient & learn from it

Facilitative Behaviors During Crises

• Listen actively• Use touch cautiously• Assess through interaction• Provide structure• Accept survivor’s viewpoint• Non-judgmental & unconditional

acceptance• Elicit problem solving thinking• Focus on strengths• Small wins• Set expectations• Link with resources• Coordinate intervention• Reestablish routine• Follow-up

Kubler-Ross’ Stages of Grieving

Common Reactions of Survivors & Rescuers

1. Numbness, unfeeling, over-conceptualization

2. Guilt for not giving enough support, intervening soon enough, etc.

3. Social embarrassment or shame

4. Anger, resentment, bitterness over not being allowed to help

5. Fear over liability

6. Grief over loss

7. Self doubt about skills or status

8. Personal fear confronting death

9. Re-experiencing personal unresolved issues

Reactions are often mixed and complex. They can be immediate or emerge over time. Most people will experience these to some degree.

Factors associated with adaptation to trauma

1. Degree of sensory exposure (severity, frequency, and duration)

2. Perceived and actual safety of family members/significant others

3. Characteristics of recovery environment (existence/access/utilization of social support)

4. Perceived level of preparedness

5. Pre-disaster level of psychosocial functioning (coping efforts)

6. Pre-disaster level of psychosocial stress (vulnerability/resilience)

7. Interrelationship among factors of personal history, developmental history, belief system, and current and past stress reactions including previous exposure to trauma (war, assault, accidents)

Debriefing (The Mitchell Model)

1. Introduction: Ground rules, overview, limitations

2. Fact Phase: Who are you, your role, what happened?

3. Thought Phase: What was first (worst) thought?

4. Reaction Phase: Express & label feelings; ventilation; what was worst part for you?

5. Symptoms Phase: Personal signs of distress

6. Teaching Phase: Normalizing & learning, stress symptoms, effective coping

7. Reentry: Summary & closing

Debriefing is a meeting among those directly involved in crisis, usually within 24-48 hours following. It is an opportunity to share their common experience, normalize their reactions, provide and receive support, understand their reactions, and reduce the intensity of their response. It is facilitated by trained persons over 2-3 hours.

Caution: The results of debriefing are equivocal and may benefit some, be negligent or stressful to others

Common themes & concerns during debriefing

• fear of repetitions (leads to hypervigilance

• distress regarding vulnerability & relative powerlessness

• distress regarding threatened loss of control (leads to isolation)

• distress regarding feelings of responsibility (leads to guilt)

• depression and reaction to loss (leads to numbness)

• distress regarding aggressive impulses (particularly shootings)

• emotional lability (may include startle response)

• anger or rage toward victims, onlookers, media, administration

• questioning of career choice & professional identification

• reaffirmation of one’s professional & individual efficacy & competence

Research on Debriefing

• Reactions to critical incidents are highly individualized, unpredictable, and unlikely to conform to a particular model of debriefing

• Survivors who were healthy before trauma, tended to have lower PTSD (Schnyder, et al., 2001); Previous trauma and severity of symptoms after the event is the best predictor of PTSD risk (McNally, et al., 2003)

• The use of CISD is not supported by research & practice, and is usually discouraged from being used

• Risk of adverse effects increases with mandatory attendance, reliving emotional trauma, and “mixing” groups

• Crisis Management International has developed a Resilience Management Model from a strengths-based perspective and comprehensive organizational plan

• Psychological First Aid: (1) recreate a sense of safety, (2) establish meaningful social connections, and (3) reestablish a sense of efficacy.

Use of Mental Health Services Among Disaster Survivors: Mental Health Service Implementation

HR Considerations

• An impairment is not automatically an ADA disability unless it “substantially limits” behavior

• Employees do not need to disclose unless they request accommodation• An employer can ask an employee with PTSD to submit to a medical examination

related to business necessity• Pre-job offer medical exams are illegal under ADA, and applicants do not need to

submit to exam until after conditional hiring• Employer can discipline behavior (failure to meet performance or conduct

standards), even when related to PTSD, but must consider reasonable accommodations

• An employee with PTSD can ask for leave as an accommodation, permitting use of paid and unpaid leave as policy permits

• Employers should make every effort to provide support and accommodation to stakeholders

http://www.jan.wvu.edu/media/ptsd.html

Administrators and crisis coordinators have needs too

• Let your family know what you need

• Be sure to get adequate sleep, water, nutrition

• Make sure you have time to debrief with your own supports

• Share the load– don’t try to do everything alone, use the team

• Keep yourself and others informed

• Ask about each other

• Debrief at the beginning and end of the day to consolidate information

Positive Outcomes of Crises

Individual Outcomes• Motivation to change• Enhanced creativity, coping & esteem• Higher personal integration• Expanded and tested support system• Outreaching skill building• Second chance resolution• Catalytic effect on family/social/work system• Survivor advocate

Organizational Outcomes• Creates natural turning point for organization• Increases interpersonal cohesion• Identify and protect organizational vulnerabilities• Better prepare for future crises• Linkage with community resources• Improve organizational culture• Demonstrate competency & values to stakeholders• Improves organizational image and reputation• Increase organizational commitment• Assessment of leadership potential “under fire”• Opportunities for new initiatives